AccountId: 011433970860
ContactId: e8f80605-da64-4b4b-957f-c9fe271bd64a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238300 ms
Total Talk Time (AGENT): 112898 ms
Total Talk Time (CUSTOMER): 72522 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/e8f80605-da64-4b4b-957f-c9fe271bd64a_20250617T17:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for contacting UT. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. I'm calling from provider's office and looking for a claim clarification.
[AGENT][NEUTRAL] I can help with the claim, [PII]. What's that policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 02460661.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Name is [PII], [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I understand you have a claim, uh, denied claim from us. What is that date of service, please?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] I see. OK, thank you. And the bill amount?
[CUSTOMER][NEUTRAL] $332 even.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] And, uh, you've already received the denial from us, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, we have received it as non-covered.
[AGENT][POSITIVE] Yes, and how can I help you?
[CUSTOMER][NEUTRAL] So I'm looking for the clarification why it was denied.
[AGENT][NEGATIVE] This is a secondary or gap insurance and what it does is it covers treatments within the physician's office, but it does not cover the office visit copay. So there's no benefit within this policy for the office visit co-pay, and that's why it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so office visit is not covered under the member plan, right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] So what's the plan name?
[AGENT][NEUTRAL] It is APL and it is a gap insurance.
[CUSTOMER][NEUTRAL] Uh, could you repeat?
[AGENT][NEUTRAL] Yes, it's the, the name of the the name of our company is ATL.
[AGENT][NEUTRAL] And it's called, it's the type of plan is it it it's called is a gap insurance.
[CUSTOMER][NEUTRAL] All right. Bye.
[CUSTOMER][NEUTRAL] What's the plan name?
[AGENT][NEUTRAL] ATL.
[CUSTOMER][NEUTRAL] Member's plan name.
[AGENT][NEUTRAL] The the the member's plan name is.
[CUSTOMER][NEUTRAL] Uh start from A alpha.
[AGENT][NEUTRAL] A as in Alpha, P as in Papa, L as in Lima. That is the members plan name.
[CUSTOMER][NEUTRAL] OK. A alpha, P, Peter, L Lima, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So plan name is APL.
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] Then
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So, under this plan, the office visit is not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So can we bill the patient?
[AGENT][NEUTRAL] Well, I, I can't really tell you that, [PII]. I can just, uh, they may have another policy because this is a secondary policy. The only thing that I can tell you is that we can't make that payment because it's not covered under their policy at all. Now is this the only claim that we're looking for? Is there anything else that we needed to look at?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, I have only one member.
[AGENT][NEUTRAL] OK, yeah, so, um, uh, they may have another policy. Uh, you may want to check with them on that, uh, because this is a secondary policy, but, uh, under their member plan, uh, the office visit is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what's the call reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we are going to use this and today's date as our reference.
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] Yes, certainly. It's uh [PII]
[AGENT][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Thank you. Thank you. Have a nice day.
[AGENT][NEUTRAL] OK, well thank you for contacting ATM.